Maraviroc Brand Name– Selzentry
What is Maraviroc
Maraviroc is an antiretroviral agent indicated for the treatment of CCR5-tropic HIV. It was the first antiretroviral approved that blocked HIV entry into human cells via its predominant entry route, the CCR5 co-receptor.
There are 2 co-receptors that allow HIV entry into CD4 cells: CCR5 and CXCR4.
Maraviroc is only effective at reducing viral load in patients with CCR5-tropic HIV strains; it is not effective against virus targeting the CXCR4 co-receptor (i.e., CXCR4-tropic HIV) and has a limited effect against virus with the ability to target both receptors (i.e., dual-tropic HIV).
CXCR4-tropic and dual-tropic HIV strains are common in patients who have been infected with HIV for several years therefore, a tropism assay of the HIV strain is necessary prior to treatment.
Hepatotoxicity has been reported with use of maraviroc and may be accompanied by signs or symptoms of a systemic allergic reaction. In clinical trials, adult patients who were at increased risk of cardiovascular events experienced such events including myocardial ischemia and infarction.
Maraviroc is a substrate of CYP3A and dosing is reliant upon concurrently administered drugs.
Maraviroc was granted accelerated conditional approval by the FDA in August 2007, and full approval in November 2008 for treatment-experienced adults.
The FDA approved maraviroc for use in treatment-naive adults in November 2009; it was approved in pediatric patients 2 years and older weighing at least 10 kg in November 2016
Indications
- human immunodeficiency virus (HIV)
- human immunodeficiency virus (HIV) infection
- human immunodeficiency virus (HIV) prophylaxis
NOTE: Maraviroc must ONLY be used in patients with CCR5-tropic HIV infection. Tropism testing conducted on a current sample should guide treatment; do not use in patients with dual or CXCR4-tropic HIV, as efficacy was not demonstrated in a phase 2 study of this patient group.
NOTE: As compared to treatment with efavirenz, treatment-naive adults treated with maraviroc experienced more virologic failure and lamivudine resistance.
Side Effects
- abdominal pain
- acne vulgaris
- alopecia
- anemia
- angina
- anxiety
- arthralgia
- candidiasis
- cirrhosis
- conjunctivitis
- constipation
- cough
- Cushingoid features
- depression
- diarrhea
- dizziness
- Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
- dysesthesia
- dyspnea
- edema
- ejaculation dysfunction
- elevated hepatic enzymes
- eosinophilia
- erythema
- fever
- flatulence
- folliculitis
- gynecomastia
- heart failure
- hepatic failure
- hepatitis
- hepatotoxicity
- hyperamylasemia
- hyperbilirubinemia
- hypertension
- infection
- influenza
- insomnia
- jaundice
- lipodystrophy
- memory impairment
- meningitis
- myalgia
- myocardial infarction
- nasal congestion
- nausea
- neutropenia
- new primary malignancy
- ocular infection
- orthostatic hypotension
- osteonecrosis
- paresthesias
- peripheral neuropathy
- pruritus
- pseudomembranous colitis
- rash
- rhabdomyolysis
- rhinitis
- seizures
- sinusitis
- Stevens-Johnson syndrome
- stroke
- syncope
- thrombosis
- toxic epidermal necrolysis
- tremor
- visual impairment
- vomiting
Monitoring Parameters
- blood glucose
- CBC with differential
- CD4+ T cell count
- hepatitis B serology
- LFTs
- plasma hepatitis C RNA
- plasma HIV RNA
- pregnancy testing
- serum bilirubin (total and direct)
- serum cholesterol
- serum creatinine
- serum lipid profile
- urinalysis
Contraindications
- Asian patients
- autoimmune disease
- breast-feeding
- cardiac disease
- children
- dialysis
- fever
- geriatric
- Graves’ disease
- Guillain-Barre syndrome
- hepatic disease
- hepatitis
- hepatitis B and HIV coinfection
- hepatitis C and HIV coinfection
- hepatotoxicity
- human immunodeficiency virus (HIV) infection resistance
- immune reconstitution syndrome
- infants
- infection
- myocardial infarction
- neonates
- orthostatic hypotension
- pregnancy
- renal failure
- renal impairment
- serious rash
Interactions
- Acetaminophen; Propoxyphene
- Adefovir
- Aldesleukin, IL-2
- Aliskiren; Amlodipine
- Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
- Amiodarone
- Amlodipine
- Amlodipine; Atorvastatin
- Amlodipine; Benazepril
- Amlodipine; Celecoxib
- Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
- Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
- Amlodipine; Olmesartan
- Amlodipine; Telmisartan
- Amlodipine; Valsartan
- Amoxicillin; Clarithromycin; Lansoprazole
- Amoxicillin; Clarithromycin; Omeprazole
- Amprenavir
- Apalutamide
- Aprepitant, Fosaprepitant
- Armodafinil
- Atazanavir
- Atazanavir; Cobicistat
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Bexarotene
- Boceprevir
- Brigatinib
- Cabozantinib
- Capmatinib
- Carbamazepine
- Carvedilol
- Ceritinib
- Chloramphenicol
- Cidofovir
- Cimetidine
- Ciprofloxacin
- Clarithromycin
- Clobazam
- Cobicistat
- Colchicine; Probenecid
- Conivaptan
- Cyclosporine
- Dabrafenib
- Daclatasvir
- Danazol
- Darunavir
- Darunavir; Cobicistat
- Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Deferasirox
- Delavirdine
- Dexamethasone
- Dextromethorphan; Quinidine
- Diltiazem
- Dronedarone
- Duvelisib
- Efavirenz
- Efavirenz; Emtricitabine; Tenofovir
- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Elbasvir; Grazoprevir
- Elexacaftor; tezacaftor; ivacaftor
- Eliglustat
- Eltrombopag
- Elvitegravir
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Encorafenib
- Enzalutamide
- Erythromycin
- Erythromycin; Sulfisoxazole
- Eslicarbazepine
- Ethanol
- Etravirine
- Felbamate
- Flibanserin
- Fluconazole
- Fluoxetine
- Fluoxetine; Olanzapine
- Flutamide
- Fosamprenavir
- Fosphenytoin
- Fostamatinib
- Furosemide
- Gemfibrozil
- Glecaprevir; Pibrentasvir
- grapefruit juice
- Idelalisib
- Imatinib
- Indinavir
- Isavuconazonium
- Isoniazid, INH; Pyrazinamide, PZA; Rifampin
- Isoniazid, INH; Rifampin
- Itraconazole
- Ivacaftor
- Ixabepilone
- Ketoconazole
- Lapatinib
- Ledipasvir; Sofosbuvir
- Leflunomide
- Lesinurad
- Lesinurad; Allopurinol
- Letermovir
- Lomitapide
- Lopinavir; Ritonavir
- Lorlatinib
- Lumacaftor; Ivacaftor
- Lumacaftor; Ivacaftor
- Mefloquine
- Mifepristone
- Mitotane
- Modafinil
- Nafcillin
- Nefazodone
- Nelfinavir
- Neratinib
- Netupitant, Fosnetupitant; Palonosetron
- Nicardipine
- Nifedipine
- Obeticholic Acid
- Octreotide
- Ombitasvir; Paritaprevir; Ritonavir
- Omeprazole; Amoxicillin; Rifabutin
- Oritavancin
- Osimertinib
- Oxcarbazepine
- Pazopanib
- Perampanel
- Perindopril; Amlodipine
- Phenobarbital
- Phentermine; Topiramate
- Phenytoin
- Pirfenidone
- Ponatinib
- Posaconazole
- Primidone
- Probenecid
- Propafenone
- Propoxyphene
- Quinidine
- Quinine
- Ranolazine
- Ribociclib
- Ribociclib; Letrozole
- Rifabutin
- Rifampin
- Rifapentine
- Rifaximin
- Ritonavir
- Rolapitant
- Sapropterin
- Saquinavir
- Simeprevir
- Sofosbuvir; Velpatasvir
- Sofosbuvir; Velpatasvir; Voxilaprevir
- Sorafenib
- St. John’s Wort, Hypericum perforatum
- Tacrolimus
- Telaprevir
- Telithromycin
- Telotristat Ethyl
- Temsirolimus
- Teriflunomide
- Testosterone
- Tezacaftor; Ivacaftor
- Ticagrelor
- Topiramate
- Trandolapril; Verapamil
- Tucatinib
- Valproic Acid, Divalproex Sodium
- Vemurafenib
- Verapamil
- Voriconazole
- Zafirlukast
- Zonisamide
